Gastric Adenocarcinoma

Most common malignancy of the stomach

Aetiology

Risk factors

  • H. pylori infection
  • Chronic gastritis
  • Smoking
  • Food preservatives (nitrates)
  • Smoked food
  • High salt intake
  • Family history

Pathophysiology

  • Most adenocarcinoma are in the pylorus/antrum and predominantly along the lesser curve

Intestinal type

  • Exophytic mass with histology representative of the intestinal epithelium
  • Slightly better prognosis - well differentiated

Diffuse type

  • Arise from normal gastric mucosa
  • Expands/infiltrates the stomach wall
  • Can result in linitis plastica - whole stomach becomes rigid as it is overgrown by cancer, discrete lesion difficult to identify
    • ‘Signet ring’ morphology - nucleus is squeezed to the edge of the cell and the remainder of the cell is distended by mucin

Clinical presentation

Symptoms

  • Dyspepsia
  • Epigastric pain
  • Loss of appetite
  • Weight loss
  • Bloating/fullness
  • Iron deficiency anaemia
  • Dysphagia
  • Menaena (haematemesis is unusual)

Signs

  • Palpable mass
  • Palpable lymph nodes - propensity to spread to ‘Virchow’s Node’ (single lymph node in left supraclavicular fossa)

Investigations

  • Gastroscopy + biopsy
  • LFTs to look for liver metastases
  • Staging - CT, USS etc.

Management

  • Curative - surgical resection
  • Palliative - stenting if gastric outlet obstruction